Health center releases long-term plan for financial stability

The North Country Family Health Centers work plan for ensuring its long-term success should bring the clinic to a break-even point by years end, Samaritan Medical Center officials said Monday.

From improving revenue to information technology to education and development for the board of directors, the 42-year-old nonprofit, under temporary operator Samaritan, has outlined a number of areas that need to change in order to strengthen operations.

It really is an overall good picture at this point, said Thomas H. Carman, Samaritans president and chief executive officer.

On Oct. 10, the state Department of Health appointed Samaritan Medical Center as temporary operator of the former North Country Childrens Clinic, just two days after the clinic announced it would close because of mounting financial trouble. Samaritan provided a loan of up to $200,000 to ensure clinic operations were sustained at least a month after that decision. A $100,000 loan also has been secured through the Northern New York Community Foundation, as has a $32,500 grant from the New York State Health Foundation. A $100,000 funding request from a third party also is pending.

Throughout the past three months, hospital administration and staff, health center staff and board members and the state Department of Health developed the work plan, which includes five other key components: reducing expenses, exploring loan and grant opportunities, restructuring financial obligations and debt, improving vendor relations and reapplying for its federally qualified health center status.

Because of changes that will be made in clinic operations and structure, the agency expects to end the year at about break-even, but with a positive cash balance.

Mr. Carman said there was no one reason the health center, 238 Arsenal St., nearly closed in October.

The toughest time for a clinic is September and October, he said. Youre coming off summer when school-based health centers are closed. Youre beginning to start a new (federal Women, Infants and Children supplemental feeding program) year Oct. 1. The complicating fact this year was the government shutdown. I still think any federally qualified health center probably does need to have a small line of credit.

One of the clinics many financial woes was delayed payment of about $275,000 in pass-through federal grant money, which Mr. Carman said the clinic finally has received.

Because the mission of the clinic is to treat every patient regardless of ability to pay, the agency relies on a mix of revenue sources. Since becoming a federally qualified health center, Finance Director Kelly Clark said, the Medicaid reimbursement rate increased by about 10 percent since June 2012.

Mr. Carman credited her dedication and the work of interim Executive Director Joey Marie Horton as a central reason the work plan came together.

As a federally qualified health center, the agency receives $750,000 per year, and will work toward implementation of the federal 340-B program, which will allow it to purchase supplies, such as vaccines, at significantly reduced costs. Mr. Carman said there are also other perks.

Being a federally qualified health center, we can participate in the federal tort program (providing malpractice insurance), and probably save about $90,000 a year as a result of that, he said.

Cost reductions also came in the form of cutting seven positions through attrition and another anticipated one this spring, and the layoff of five employees, three of which occurred in December. Two managers  the adult medical coordinator and the dental coordinator  were laid off Monday. Interviews for the new position of clinical operations director will take place this week, according to Mrs. Horton.

Throughout the next three to four months, Mr. Carman said, Samaritan hopes to make a smooth transition for health center staff. Hospital officials already have helped clinic staff work toward reapplying for a one- to three-year extension of federal health center status and funding.

Two components of serving the homeless and opening a medical/dental clinic in Lowville were included in the original application and remain part of the application for the new designation.

New funding streams will focus on grants, Mr. Carman said, because we dont want more loans on the books; its hard to dig out from that.

He said the clinic will work toward sustainability by outsourcing billing, reducing no-show rates by changing the way appointments are booked, refinancing the $1.1 million mortgage on the clinic, paying back loans and addressing the $180,000 owed to vendors. Improving data collection and collaborating with the community to enhance the board also are part of the work plan.

About one month after the clinics October troubles, which included the resignation of then-Executive Director Daniel A. Wasneechak, board President Angela M. Gray also stepped down. There has not been a replacement since, but that is something Mr. Carman said will change. A new configuration of the board will add some members to draw from a broader range of experience and expertise.

An outside agency, with the help of Samaritan, will train the entire board on how better to lead the clinic and to understand the intricacies of health care financing.

Mr. Carman said although Samaritan is helping the clinic, the clinic will not be a subsidiary of the hospital. The two organizations could, however, continue to work in partnership.

saving the clinic

Key elements in saving the North Country Family Health Center include:

n Seeking more loan and grant sources to augment other clinic revenue streams.

saving the clinicKey elements in saving the North Country Family Health Center include:• Improving revenue by outsourcing billing, reducing no-show rates, increasing reimbursement rates• Reducing expenses by reducing staff by a net of 13 positions and restructuring operations• Restructuring and reducing debt by paying off unsecured debt and refinancing a $1.1 million mortgage• Improving information technology by subcontracting to improve the efficiency of the centers electronic medical records program• Seeking more loan and grant sources to augment other clinic revenue streams

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